Effecacy of two-level infrainguinal reconstructions in treatment of chronic critical lower limb ischaemia

Pshenichny V.N.^1,2, Shtutin A.A.^1,2, Ivanenko A.A.^1,2, Voropaev V.V.², Kovalchuk O.N.², Gaevoi V.L.²

1) Donetsk State Medical University,
2) Department of Vascular Surgery V.K Gusak Institute of Emergency and Restorative Surgery, Donetsk, Ukraine

Objective: to determine the scope of infrainguinal revascularization of the limb in patients with multilevel lesions of arteries in chronic critical lower limb ischaemia (CCLLI).

Patients and methods. A retrospective analysis of graft patency and limb salvage included a total of 76 patients undergoing a total of 78 bypass procedures consisting of: 1) two-level infrainguinal reconstructions (n=35), 2) femoral-tibial (n=36) and femoral-plantar (n=7) bypass procedures. All patients had an isolated segment of the popliteal artery in a combination with bifurcation arterial occlusive disease. Autovenous reversed retrograde and orthotopic (in situ vein grafts were used). All patients underwent intraoperative haemodynamic measurements. Graft patency was assessed by Doppler monitoring. The two groups studied were compared by demographic features and risk factors by means of the Student’s and chi-squared tests.

Results and discussion. Life-table analysis showed demonstrated that two-level infrainguinal reconstructions provided better primary 3-year patency (76.2%) as compared with femoral-tibial and plantar bypasses (60.4%, p<0.05). Intraoperative mortality occurred in 2 patients (2.5%).

Early and mid-term thromboses appeared to be most frequently encountered in the group of femoral-tibial, and plantar reconstructions (18.6% vs 11.4%, p<0.38 and 30.8% vs 10.3%, p=0.04, respectively).

Conclusion. Two-level infrainguinal arterial reconstruction in patients with CCLLI is an acceptable procedure alternative providing better graft patency higher limb salvage rate as compared with femoral-tibial or femoroplantar bypass.

KEY WORDS: critical lower limb ischaemia, surgical treatment, infrainguinal reconstruction.

P. 137

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